Day surgery: How far can we go and are there still any limits?

Current Opinion in Anaesthesiology

Volumn 20, Issue 6, 2007, Pages 503-507

  Qadir, Nusrath ^a   Smith, Ian ^a  

^a UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE   (United Kingdom)

Author keywords

Ambulatory anaesthesia; Postoperative complications; Preoperative assessment; Selection criteria

Indexed keywords

AMBULATORY SURGERY; CLINICAL PRACTICE; GENERAL ANESTHESIA; HOSPITALIZATION; HUMAN; LAPAROSCOPY; LOCAL ANESTHESIA; MEDICAL TECHNOLOGY; NEPHRECTOMY; OBESITY; PATIENT CARE; POSTOPERATIVE COMPLICATION; PRIORITY JOURNAL; REVIEW; SURGICAL TECHNIQUE;

AMBULATORY SURGICAL PROCEDURES; ANESTHESIA; ENDOSCOPY; HUMANS; OBESITY; POSTOPERATIVE COMPLICATIONS; RISK ASSESSMENT;

EID: 35948956698     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/ACO.0b013e3282f0320e     Document Type: Review

References (25)

1. NHS Institute for Innovation and Improvement. Focus on: cholecystectomy. Coventry: NHS Institute for Innovation, University of Warwick Campus; 2006. Available from enquiries@institute.nhs.uk. A common pathway for the care of all patients undergoing laparoscopic cholecystectomy is proposed, based on expert opinion and best practice. Elective patients undergo targeted investigations before specialist referral and concurrent preassessment with subsequent day of surgery admission. Emergency cases should be rapidly investigated, preassessed and undergo surgery during the acute admission. Any patient meeting discharge criteria should be discharged on the day of surgery.
2. Golash A, Selvan M, Braithwaite D, et al. Day case laparoscopic simple nephrectomy - is it feasible? [Abstract]. J One-day Surg 2006; 16 (Suppl):A13.
3. Golash A, Luscombe C, Rajjayabun P, et al. The expansion of laparoscopic day case major urological procedures: an initial experience [Abstract]. J One-day Surg 2007; 17 (Suppl):B1. The authors describe how they have extended their experience with the world's first true day-case laparoscopic simple nephrectomy, and have now performed a successful series of transperitoneal advanced urological laparoscopic procedures. The series includes six nephrectomies (including one radical nephrectomy), six pyeloplasties and four adrenalectomies for Conn's syndrome. Operative times ranged from 1.3 to 3 h with no major immediate or delayed complications. Pain was manageable with oral analgesia and patient satisfaction was good. Subsequently, the team have successfully performed at least one further day-case radical nephrectomy (I. Smith, A. Golash, personal communication).
4. Bertrand OF, De Larochellière R, Rodés-Cabau J, et al. A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation. Circulation 2006; 114:2636-2643. A total of 1005 patients undergoing uncomplicated transradial percutaneous coronary artery stent implantation were pretreated with aspirin and clopidogrel and a single bolus of 0.25mg/kg abciximab. Then 501 patients were randomized to receive a standard 12 h infusion of abciximab and an overnight stay; the remaining 504 patients received no infusion and were discharged after an observation period of 4-6 h without any detriment in terms of all major outcomes.
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8. Gilliard N, Eggli Y, Halfon P. A methodology to estimate the potential to move inpatient to one day surgery. BMC Health Services Res 2006; 6:78. http://www.biomedcentral.com/1472-6963/6/78. [Accessed 27 July 2007] An algorithm based on surgical access (endoscopic or open), organ size and invasiveness identified operations suitable for day surgery according to basic principles. Expert review suggested that only a relatively small number of the identified procedures needed to be reclassified (from day case to inpatient or vice versa) based on more specific factors. The model could be useful in identifying the potential to move inpatient procedures to day surgery in various countries and the associated cost savings.
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24. American Society of Anesthesiologists. Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology 2006; 104:1081-1093. Obstructive sleep apnoea is not always formally diagnosed but should be suspected when frequent sleep disturbance is associated with daytime somnolence. Opioid analgesia should be avoided where possible, and if the patient has a continuous positive airway pressure device this should be used before and after surgery.
25. Fleisher LA, Pasternak LR, Lyles A. A novel index of elevated risk of inpatient hospital admission immediately following outpatient surgery. Arch Surg 2007; 142:263-268. The authors combined a number of risk factors to produce an outpatient surgery admission index to help identify day-case patients at higher risk of immediate hospital admission.